"I like a good story, well told. That is the reason I am sometimes forced to tell them myself." - Mark Twain

Monday, October 6, 2014

Epidemic Management 101: How it works when your head's not up your @$$

As all of us have watched aghast, for over a week, as public officials have screwed up virtually every component of the arrival to our shores of Ebola, and the ASPCA deploys hundreds of inspectors based on eyewitness accounts of hundreds of cases of pooch-screwing in Washington D.C. and Dallas, we've all had a rising sense, not of panic, but of outrage at what's being perpetrated against us.And person after person knows in about 1 second what to do, but nobody in authority wants to talk about it, and the media cheerfully glosses over it. (It's a little less funny when one of your cameramen is facing a grisly death though, isn't it, NBC? Actions have real-world consequences. Pity you couldn't have thought that out sooner.)And the solution is blazingly simple:STOP UNKNOWINGLY FLYING INFECTED PEOPLE HERE, AND RISK IMPORTING MORE EBOLA.Nota bene I'm not talking about not evacuating America medical workers here with known EVD infection, and whisking them, hermetically sealed into BL4 bubbles, right into one of those 23 beds I told you about the last few days. If such transfers can be arranged for American nationals, and there's space available, knock yourselves out. That's not a problem, then or anytime for the foreseeable future.But as we've seen one assclown put an entire nation at risk, and terrorize thousands of residents of one city, force a quarantine of 50 (at one point 100) contacts, and leave thousands of children and their parents worried, frightened, and shell-shocked at this turn of events, there isn't any excuse for failing to take this fundamental containment step right goddamned now.Read the comments of my last blog post or two, just as I hear the comments in other forums: commercial aircrew are not being told the truth about their risks, they know that flights to affected/infected countries are risky, and they're afraid not only of exposure of themselves and their passengers to Ebola, but of becoming the delivery vehicle of a pestilence to entire nations by the hundreds, thousands, or worse. Nobody want to be flying Ebola Airlines' Pandemic Plague Express flights back to their own homes.And they're absolutely right to have such concerns. They can't run an isolation ward at 35,000', their crews and passengers shouldn't be in that position, and there's no bloody excuse to be putting them on the front lines.If that offends anyone in Liberia, Guinea, or Sierra Leone, leadership for someone with a Nobel Peace Prize for 12 days' work should include the ability to explain to their people and their leaders that they should learn to suck it up and deal with it, starting with a famous American phrase two words long, which starts with "Fuck" and ends with "you!"Can't hang with that, peeps? Too damned bad. Thomas Duncan screwed it up for all of you. Everybody out of the pool. Effective five minutes ago, you direct the FAA to issue no-fly orders for any US carrier to those three countries, and revoke landing rights for any other carriers' flights from there to here, direct or indirect.Mercy flights to bring in supplies, and bring out their own people are allowed, but subject to full scrutiny and rigorous health and safety inspections, coming and going. Commercial and charter passenger service here, from there, is over until further notice.You further direct Customs and Immigration that anyone who's travelled to those countries, or who resided there any time since last April, and arriving here via any other carrier or from any other country will be denied a visa to enter the US until they complete a 21-day total isolation at a containment facility, at their expense, billable upon arrival, and non-negotiable. There will be bars on the doors, guards on the fence, and MREs three meals a day. Once you finish that term of quarantine, "Welcome to America!". If you're very nice, we may provide complementary cable TV while you wait. If you become symptomatic of Ebola or anything else communicable while you wait, you'll be transported in a containment bubble back to your country of origin, and deposited there for your friends, neighbors, countrymen, and government to deal with. And if anyone in authority in those three countries issues any other statement in response that isn't "We totally understand and respect the right and responsibility of the U.S. government to protect its people", why then we'll be only too happy to withdraw all aid to them same day, and direct the exact amount that was to have been spent on medical aid to instead be shipped off in the form of ammunition in calibers suitable for the weapons carried by the border guards of the contiguous and uninfected countries. Such shipments to be announced and televised live within the hour. The days of shitting on us for helping you are over.Any countries with new outbreaks that show the epidemic has arrived there, dug in, and is spreading out of control get added to the list, and the same rules.Then you announce the borders of the US are closed to illegal entry, and if DHS via Border Patrol can't seem to make that stick, we'll be only too happy to deploy combat troops with shoot on sight orders, and/or nationalize state guard troops and send them out as well, with the same Rules of Engagement. Trespass over the border, die there. The Air Force, Navy and Coast Guard are given free reign to interdict any trespassers and smugglers of any type under the same ROE as well.You want to line up at the gates at ports of entry, and come here like ladies and gentlemen, all is well and good.Try it any other way, and your problems are over permanently; our troops can use the marksmanship practice.The beauty of all this is it infringes no one's civil or constitutional rights here whatsoever. It's all legal under international law and every treaty we've ever signed.Then, someone grabs Frieden at CDC, raps him on the forehead, and suggests he's got about a New York minute to pull his head out of his ass, figure out what resources it's going to take for the next virus incident like Dallas, at tell him he's got a second minute to start formulating detailed and comprehensive plans for a response that looks like the Marines landing on Iwo Jima the next time someone's Ebola test pops positive anywhere in America.Such response to include, at a minimum, detailed flow charts for coordinating the city, county, and state responsibilities and positive performance checks so we don't see more of the sort of egregious assclownery we saw in Dallas:hospitals thoroughly unprepared to spot, assess, and appropriately care for Ebola patients;health departments too stupid to supervise idiot workers and keep them from pressure-washing infectious material all over a neighborhood;city government imprisoning people in a house full of known deadly infectious material for four days after the patients' status is known, and taking even longer to arrange to decontaminate the premises properly and safely.And by the end of the week, I want drills for simulated casualties to be conducted in every major city from coast to coast, publicized and covered carte blanche and full access by the news media, including anyone with a camera or a notebook, even if they blog in their pajamas, with the successes and failures reviewed in open public meetings in each case, and rigorously examined by medical and governmental officials to fix the problems, unsnarl the tangles, blow open the bottlenecks, and pass on the lessons learned to everyone in real time, including online updates around the clock. There also needs to be an 1-800-WTF? hotline so that anyone, in any city, who has any comments, questions, or problems related to Ebola, the management of an outbreak, or what they should do, can call in and get help right now, staffed by experts around the clock, until the outbreak is no longer a problem. If somebody's cousin is puking blood and he doesn't know what else to do, they can call that number. If a fire crew isn't sure what they should do with a guy down at the mall, they can call. If a mayor, or hospital administrator, or county board of health has a question, they can call. And so on.The one thing the government absolute can and should do when this kind of thing happens, is be putting out straight and complete information, and facilitating rapid coordination of any and all agencies required from the dog catcher to the Department of Defense.If the community hospital in BFE wants to do a training seminar on handling a potential Ebola patient, they should have a 40# box of info sheets, posters, etc. FedExed to that hospital same-day. If Jerkwater County is holding an Ebola patient drill, from the point of a drill victim collapsing at the mall, all the way to putting them in a sealed ICU and caring for them until they get better, get transferred, or die, there should be a member or team from the Public Health Service and CDC standing right next to the drill supervisors to hold their hands, answer questions, and make sure they're clear on how to do it right through every step, as a public service.That this will build trust and relationships the next time there's a Cat V hurricane, flood, tornado, or earthquake is a serendipitous bonus for future disaster responses, and helping local folks do what they do best, which is take care of business.Americans can do damned near anything they put their minds to.The only thing the federal government needs to do, is their owned damn jobs, which include advice and assistance, but primarily doing their best to never have to explain why and how another Thomas Duncan slipped in here in the first place.Get rid of that screen door on the submarine, and an amazing amount of other concerns disappear. Overnight, it would instantly restore the protection long afforded us by our 2000-mile wide natural moats, the Atlantic and Pacific Oceans.And all that should start with an open and public apology for ever leaving the safety of the entire American people in the hands of some guy in the Monrovia airport, with a fourth grade education, a clipboard, and a thermometer.Stop that, fix the rest, and get the hell out of our way, and we'll all get along through this just fine.Will any of that happen?Of course not.Fearless Leader is an incompetent fabulist (any way you care to parse that sentence).He surrounds himself with sycophantic toadies renowned far and wide for their inability to hear anyone over the sound of their own awesomeness.So in all likelihood, the Duncan Scenario will repeat itself over and over until the disease comes over the levees like a Cat V Hurricane hitting New Orleans, and after that, well...Welcome to Liberia II: The Sequel.

8 comments:

Anonymous
said...

Sounds like a plan....except for one thing that occured to me. Apparently a male ebola survivor is still contagious for some weeks after, through semen. I guess proper testing would screen out even that loophole, but that's a big ask when even the basics seem so hard. Almost as if someone's begging for a hot epidemic in the West.

The presumable disease reservoir in Africa is fruit bats, which live in the tropics worldwide.

The bigger issue is if it can find a benign host mammal species or three among native populations here (think bats/rats/polecats, etc.). If that happens, it can become endemic anywhere, and we'll never be rid of it.

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Not counting the news outlets or websites along the full range of accuracy and veracity, I follow 10 or so actual individuals' handwritten blogs. Looking them over, 8 of the 10 are current serving or former military and 4 of those 8 are some variation of high-speed low-drag elite forces ninjas. And 2 are cops.So in other words, the same folks I trusted in the military not to wet the bed, sh*t themselves, or otherwise run around like headless Nancys, are the same folks I trust on the interwebz, for demonstrating pretty much the same trustworthiness and circumspectly responsible behavior.Color me shocked.

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